By Chris Kahn for Bankrate.com
It's hard to be flexible on a fixed income. That's why some of America's prettiest, most vibrant locations are also some of the toughest on retirees.
They're usually more expensive, for example, with higher rents and more expensive restaurants. Tax rates also tend to be higher in urban areas. They also may not be as safe.
With that in mind, Bankrate ranked each state based on a variety of factors that everyone should consider before making a move into -- or out of -- their home state. They include a specialized cost-of-living index for retirees, crime statistics, tax rates and comprehensive weather data that factor in sunshine and humidity. Also new this year: Bankrate beefed up its ranking for health care quality, and consulted an extensive survey called the Gallup-Healthways' Well-Being Index. The index gauges the level of satisfaction residents report about their surroundings.
The states that fell to the bottom of our list still have a lot to offer. In fact, many are home to the top tourism destinations in the world. The problem, in the end, is that choosing a good place to retire isn't as easy as picking a vacation spot. Costs matter more. The local culture and infrastructure also matter.
Here, in descending order, are 10 of the lowest-ranking states for retirees based on our criteria.
Kentucky's low cost of living is easy on the budget, and it's of course a basketball lover's dream.
The biggest problem for Kentucky residents is the state's health care system and low wellness scores.
The Agency for Healthcare Research and Quality, or AHRQ, gave Kentucky's health care system its fifth-lowest score in the nation as part of its most recent quality report. The agency, which is part of the Department of Health and Human Services, has found numerous issues with Kentucky's health care. It noted, for example, especially high rates of adults who didn't receive timely care even though they needed it "right away" for an illness or injury.
Gallup-Healthways, which tracks emotional and physical well-being as part of an extensive national survey, gave Kentucky its second-lowest score behind West Virginia.
The primary knock on Maryland is that it's more expensive to live there than in many other states. The cost of living for retirees is especially high, and residents pay one of the highest tax rates in the country.
According to the latest analysis from the Council for Community and Economic Research, retirees can expect to pay $1.12 more than the national average for a movie ticket and $9.58 more for a trip to the beauty parlor. Medications like Lipitor and ibuprofen also are higher than the national average.
The Tax Foundation calculates that Maryland residents pay 10.6 percent of their combined income in various state and local taxes. Its analysis, which includes property and sales taxes, says that Maryland is the seventh-highest taxing state in the country.
Maryland also posted low scores for health care quality, and its crime rate is above the national average.
Oklahoma sank into Bankrate's bottom 10, thanks to low scores in three main areas.
Gallup-Healthways gave the Sooner State its ninth-lowest score in the country. It's not surprising that the index, which asks residents about their emotional and physical health as well as how safe they feel, placed Oklahoma so low.
Oklahoma's crime rate is one of the highest in the nation, with 3,870 violent and property crimes per 100,000 people. It also has one of the worst health care systems in the country, according to a government analysis.
The Agency for Healthcare Research and Quality gave Oklahoma the fourth-lowest score in the nation in terms of health care quality. The agency noted, for example, that the state has a poor record of delivering mammograms to women between 50 and 74. Patients at Oklahoma hospitals also gave their doctors and health clinics below-average satisfaction scores.
Louisiana is a relatively cheap place to live, with a light tax burden and low cost of living. It's everything else that's pushed the Pelican State to the bottom of this year's list.
Crime is a problem in Louisiana, with relatively high property and violent crimes. It also posted poor health care quality scores and a low ranking on the Gallup-Healthways' wellness survey.
The weather can also be tough to endure, especially over the summer. Overall, Louisiana is the second-most humid state in the country, ranking just behind Mississippi. The average morning humidity is 90 percent in Lake Charles, Louisiana. In New Orleans, it's 86 percent.
Like several other Southern states, Alabama was hit by poor health care quality and low scores from a Gallup-Healthways' survey that showed weak emotional and physical health among residents.
Dan Witters, a Gallup research director who directed the Gallup-Healthways' Well-Being Index, says states with low scores tend to follow similar patterns.
"The food they eat, basic access to health care, income, access to dentistry -- it's all really crummy. Rates of smoking are a lot higher," Witters said. "That stuff permeates throughout the community. It's consistent."
In addition, Alabama's crime rate is higher than average, and its weather is typically uncomfortably hot and humid.
If it weren't for the sky-high cost of living, Hawaii would be one of the best states in the country for retirees. Its remoteness, popular beaches, wildlife and culture make America's 50th state a top tourism destination.
It also makes it tough to afford -- especially for anyone on a fixed income.
The Council for Community and Economic Research, which tracks consumer prices around the country, found Hawaii to be the most expensive state in the country for retirees.
A loaf of bread, for example, costs an average of $2.80 in Honolulu, according to the council's 2013 analysis. That's $1.30 higher than the national average. The city's gas stations charged an average of $4.19 a gallon last year, compared with a national average of $3.44. And a trip to the beauty parlor costs an average of $52 in Honolulu, about $18 higher than the national average.
Arkansas is certainly easy on the wallet. It's the seventh-cheapest place to live for retirees, according to the Council for Community and Economic Research.
But Arkansas struggled in every other category. It had the third-highest crime rate, the sixth-lowest rating for wellness and the eighth-lowest health quality scores. It also had above-average state and local taxes, with a combined rate of 10.3 percent, according to the Tax Foundation.
It's also one of the most humid states in the country, which can make Arkansas an uncomfortable place to live during the summer.
Alaska, which is heavily supported by the oil and gas industry, asks very little of its taxpayers. The state and local tax burden is the second-lowest in the country, just behind Wyoming, according to the Tax Foundation.
It's a rare bright spot, given the number of challenges facing many of the state's retirees.
Alaska receives some of the lowest scores in the nation for health care quality. It's also one of the most expensive states, with a cost of living that's behind only Hawaii.
Oh, and it's frigid. In Anchorage, temperatures consistently hold below freezing from November to February. Sunshine is a rarity in some parts of the state. Juneau, for example, gets less sunshine than any other city monitored by the National Oceanic Atmospheric Administration.
2: West Virginia
The Mountain State puts pressure on its retirees in a number of ways. Its health care system, for example, is considered by the government to be one of America's worst, and its wellness score is at the bottom of the heap.
The Agency for Healthcare Research and Quality, which monitors state health care systems, gave West Virginia its second-lowest rating in the country. The agency noted such problems as high rates of "potentially avoidable" hospitalizations for chronic conditions and high rates of poor communication between patients and doctors.
Dr. Ernest Moy, who directs AHRQ's state snapshot report, says states with low-quality health care tend to fail at disease prevention and management. They may not have strong vaccination or anti-smoking programs, for example. Doctors in those states may not recommend as strongly as others that patients take steps to prevent disease. And patients may not be as interested in or capable of following their doctor's orders.
It's really a cultural problem that cuts into health care quality, Moy says, and retirees should consider that before they move.
"If you go into an environment where most people don't get preventive services, well, you might not want to get preventive services either," Moy says.
1: New York
This is probably not a surprise for anyone who lives (and pays taxes) in New York City. The Big Apple is home to nearly half of the state's residents, and the city's high taxes and cost of living has pushed the entire state into the very bottom of Bankrate's ranking of worst states for retirees.
It takes a lot of infrastructure to cram 8.4 million people into New York's five boroughs. Residents help pay for the extensive subway system, police force, parks staff and other services with a tax rate that's second to none.
"Higher spending is the biggest driver" for New York's 12.6 percent tax rate, says Elizabeth Malm, an economist at the Tax Foundation.
Besides the hefty tax bill, residents also deal with the fourth-highest cost of living in the country. The government also gives New York relatively low scores for health care quality, and New York received low scores in the Gallup-Healthways' wellness survey.
The weather also can be pretty rough, with frigid winters and the potential for hurricanes later in the year.
This article was originally published on Bankrate.com.